The Treatment Plan Assignment is designed to help you make application of
course content to a counseling situation. You are to read the case study,
identify key issues, provide diagnostic impressions based upon the DSM-5,
list broad treatment recommendations, and develop a treatment plan. See the
Treatment Plan Assignment Template for the format and further details. The
due date for the Treatment Plan Assignment is listed in the Course Schedule.
Treatment Plan Assignment Case Study
Presenting Problem:Adam presents as a 20 year old single Caucasian male
who was referred to counseling by his college because “my resident assistant
reports that I have a difficult time getting along with others in my dorm.” He
reports he does not believe he has a problem but does not want to be asked
to move out of the dorm so has agreed to come see a counselor.The client
reports that he does not have a lot of friends and does not desire to.Upon
meeting the counselor, Adam asks for the counselor’s credentials stating, “I
just want to ensure you have the appropriate skills.”
Present Life Situation: Adam reports that he is currently attending STATE
University and studying pre-med.He stated that he is doing exceptionally well
in his college studies and is pretty certain that he is at the very top of his
class.The client reports that he knows his placement in the dorm is in
jeopardy due to his difficulty in getting along with the other students.He notes
that he just does not think that they are of the same level mentally and socially
as him and it is difficult to get along with those who he feels are “below
me”.Adam did acknowledge that he is frequently rude with them and short-
tempered and has no desire to make relationships with the majority of
them.He reports that it is his short-temper that has resulted in him getting in
trouble as he is often the topic of complaints from the other residents in his
dorm, noting that it is mostly due to their jealousy.In addition, to these issues
Adam did report some use of marijuana.He notes that he will smoke once or
twice a month- the equivalent of a joint.He reports that he first started smoking
at the age of 18 when he first arrived at college.Adam reports that it helps him
to be creative and fully access his thoughts.He reports that recently he has
realized he needs more of the substance to obtain the same high that he was
obtaining when he first started using marijuana.In addition, he has attempted
to quit altogether but then will smoke and tell himself that he “doesn’t use that
often so what is the big deal.” Adam reports no current or previous use of
other substances.
Social and Family History: Adam reports being raised by his biological
parents and that he had a “good” home-life, but didn’t always feel as though
his parents and other brothers were of the same caliber socially, physically,
and mentally as him.He reports that he has two brothers and that he is the
youngest.The client did not report any abuse in his childhood.Adam reports
that he did well academically in school earning mostly As.He noted that he
was in the Honor Society and took some college classes on-line during his
senior year in high school.The client states that “I haven’t been IQ tested but I
bet if I was, the number would be off the charts.” Adam reports that he won
several academic scholarships due to his good grades in school.He reports
that he could have been the class valedictorian but also thought it would be
important to get into college to play sports and be involved in extra-curricular
activities such as yearbook and drama.Due to this he didn’t spend quite
enough time studying as he needed to. The client notes that he was the best
soccer player that his school had seen in quite a while and played in the
position of forward.Adam reports that it was mostly due to his effort that his
team went to the state championships during his senior year.In addition, he
notes that he always got the lead role in plays due to his “amazing acting
ability” and his “rugged good looks”. When asked about his relationship
history, Adam reports that there have been only a couple of relationships that
lasted more than a week.He notes that he is not currently in a relationship as
he has not met anyone at the university he is attending that he desired to
pursue a relationship with.
Medical History and Mental Status Exam: Adam reports no current medical
problems and reports that he last had a physical six months ago.He reports
that he attends physical exams annually because he needs to keep “my body
in tip-top shape”.The client was oriented times three as determined by a
mental status examination.Adam’s appearance was appropriate for the
situation although he was slightly overdressed for the situation with a button-
down shirt, tie, blazer, and skinny jeans.His attitude was cooperative, his
affect was normal, and his thought process appeared to be normal.The
client’s thought processes appeared to be free of any delusions and to be
based in reality.He reports no current suicidal or homicidal ideations and
denied any hallucinations.The client appears to be of above average
intelligence for his age and education level and reported that he had been
awarded several academic scholarships to college.Adam reports that he has
never received prior counseling and that no other members of his family have
ever received counseling as far as he was aware. He reported the only
medical issues in his blood relatives were that his maternal grandmother has
diabetes and his paternal grandfather has high blood pressure.
COUN 667
TREATMENT PLAN ASSIGNMENT TEMPLATE
Follow the outline below as you write your treatment plan assignment. You will have 4 major
areas to your treatment plan assignments: (1) key issues, (2) diagnostic impressions, (3) general
treatment recommendations, and (4) a treatment plan. Follow the format below when completing
your assignment. This assignment does not have to be in current APA format and you are not
required to include references. Sections I.–III. should be 3–4 pages, with additional pages for the
treatment plan. The treatment plan assignment is an opportunity for you to think through a
clinical case, identify and prioritize key issues involved, consider and clarify relevant diagnostic
issues, formulate treatment recommendations, and develop a treatment plan that are most likely
to be helpful to the client.
I. Key Issues
A. List in order of priority of importance the key issues you believe are involved in the
case study if you were the client’s counselor. Provide a rationale for the order in
which you prioritized issues. What are the most important features to you and why?
B. Link your rationale for the order of priority in A. to what you believe outcomes of
treatment should be for this client. How does your order of priority contribute to a
successful outcome for the client?
C. How might the client list a different order of priority of key issues differ from yours
(the counselor)?
D. What additional information would be helpful for you to know if you had the chance
to acquire it?
II. Diagnostic Impressions
A. Based on the information provided in the case study, use the current version of the
DSM to accurately diagnose the type(s) of mental disorder(s) involved, including the
appropriate use of specifiers. Refer to specific diagnostic criteria when presenting
your impressions.
B. Be sure to consider the presence of any other co-occurring disorder(s), including
other conditions that may be a focus of clinical attention.
C. Provide a rationale for your diagnostic impressions, giving consideration to
differential diagnostic considerations.
III. Treatment Recommendations
A. List your recommendations (e.g., 1., 2., 3., etc.) so that you can clearly delineate what
you believe will be of most help to your client. Also provide a sentence or two of
rationale for each recommendation. Be sure to consider recommendations that will be
motivating to your client and reflective of a collaborative approach.
B. Be sure to consider the biopsychosociospiritual aspects of the case. Make sure your
recommendations are relevant to the case, able to be implemented by the client, and
have some basis of support from professional literature.
COUN 667
IV. Treatment Plan
A. Develop a treatment plan using the Treatment Plan Worksheet below. As outlined on
the worksheet, this will include 1 problem statement, for the problem statement 2
goals, for each goal 2 objectives, and for each objective 1 intervention. The problem
statement must be one sentence that identifies one client problem based on the
diagnosis (-es) that takes client collaboration and motivation into account. You are
encouraged to use the Jongsma et al. text as a resource, just remember to state goals
in terms of what the client needs more of or new skill sets, to state objectives in terms
of observable client behavior (what we could actually see the client do), and to state
interventions in terms of observable counselor behavior (what we could actually see
the counselor do).
COUN 667 Treatment Plan Worksheet
Client Name: Shaun Yates
Problem 1.:
Goal 1.:
Objective 1.:
Intervention 1.:
Objective 2.:
Intervention 1.:
Goal 2.:
Objective 1.:
Intervention 1.:
Objective 2.:
Intervention 1.:
COUN 667 Treatment Plan Worksheet
Counselor Name:
Client Name: Peggy Isaac
Case #: 5-5
Problem 1.: Client is excessively worried across a number of social, occupational, financial, and
personal domains as evidenced by client report of being fearful of future events, making
mistakes, being a burden to others, being alone without help.
Goal 1.: Client will experience calm confidence in a full variety of functional domains of
daily life.
Objective 1.: Client will complete Anxiety Monitoring Form 2x/day every other
day.
Intervention 1.: Counselor will review client’s completed Anxiety
Monitoring Form in sessions and process in a manner consistent with a
cognitive behavioral approach.
Objective 2.: Client will practice progressive relaxation 3 days per week.
Intervention 1.: Counselor will train client in progressive relaxation
within first 3 sessions and inquire in session about client practice.
Goal 2.: Client will learn coping skills to increase positive self-talk that helps diminish
worry.
Objective 1.:
Intervention 1.:
Objective 2.:
Intervention 1.:
Problem 2.: Client is avoiding routine daily activities as evidenced by having groceries delivered
rather than entering the store, not going out at night, and increasing social isolation.
Goal 1.: Client will develop the coping skills necessary to comfortably engage in a range
of routine daily activities.
Objective 1.: The client will….
Intervention 1.: The counselor will…
Objective 2.:
Intervention 1.:
Goal 2.:
Objective 1.:
Intervention 1.:
Objective 2.:
Intervention 1.:
Running head: NARCISSISTIC PERSONALITY DISORDER 1
Narcissistic Personality Disorder
Your Name
Name of Institution
NARCISSISTIC PERSONALITY DISORDER 2
Narcissistic Personality Disorder
Key issues
In this case, it can be identified that the major issues involved are related to self-
fulfillment and physiological needs. Adam needs constant self-actualization, has high esteem
needs, and always wants a sense of belonging. Adam has a strong desire to achieve everything he
wants to achieve and become the best. He always wants to be seen as the best in everything and
in any group he is in. He also demands respect from other people, tries to make achievements,
and show people what he has achieved. Lastly, Adam experiences problems with socializing. He
does not like most of the people around him and feels he is superior to everyone else. This causes
him problems with others; hence, he cannot relate well with other people.
Based on the key issues noted, it is necessary to begin by addressing Adam’s sense of
belonging, then esteem, and, lastly, self-actualization. By beginning with Adam’s sense of
belonging, it would be possible to make him understand the need to accept other people’s
presence. This way, he can develop a moderated need for esteem. This is because he will not
demand too much respect or approval from others, whom he might feel are his juniors. Finally,
he will be able to cooperate with others and find a way to meet his full personal potential. Even
though this process might lead to a successful outcome, the client might have a different order of
priority based on what he considers more important to him. For instance, the client might feel
that his esteem is much more important than his sense of belonging. Hence, it would be
necessary to try to find out what the client feels is more important to him. Through a series of
questions and assessment tests, it would be possible to come up with the right order of priority to
suit the client and have perfect results.
Diagnostic Impressions
NARCISSISTIC PERSONALITY DISORDER 3
Adam has distorted thoughts about himself and his position in the world. He is convinced
that he has superior qualities that others lack. From the case, he also appears to be much focused
on his own needs and the view of rejecting anything else. It is clear that he is motivated by self-
esteem problems and repressed insecurities. He always needs approvals and praise from others
and turns hostile and defensive when he does not get what he needs. Generally, these
characteristics match what would be considered symptoms of narcissistic personality disorder.
From the DSM-5 perspective, the major characteristics of a personality disorder involve
impaired personality functioning and pathological personality traits.
The DSM-5 criteria for diagnosing a narcissistic personality disorder states that there
must be significant impairments in the functioning of personality manifested by impaired self-
functioning in identity or self-direction. In this case, Adam has impaired self-functioning in self-
direction. DSM-5 notes that this happens when an individual sets goals based on receiving
approval from other people, as can be seen in Adam. Also, an individual sets unreasonably high
standards to get the feeling of being exceptional. Adam also has problems with his identity.
DSM-5 states that excessive reference to other people for self-esteem regulation and self-
definition or exaggerated self-appraisal shows unstable self-esteem.
Adam shows these characteristics. DSM-5 diagnosis also includes impairment in
interpersonal functioning as a major criterion for determining narcissistic personality disorder.
This involves empathy, where one cannot recognize the feelings of other people and intimacy,
which can only exist if it serves self-esteem regulation in the individual. The individual only
maintains superficial relationships. Adam experiences all these symptoms and is, therefore,
suffers narcissistic personality disorder.
NARCISSISTIC PERSONALITY DISORDER 4
Treatment recommendation
Based on Adam’s state, the main form of treatment should be:
i. Psychotherapy
ii. Treatment for addiction problems
iii. Medication
Psychotherapy is the main approach to treating narcissistic personality disorder. This form of
treatment can help Adam learn how to cooperate with other people in order to gain functional
interpersonal relationships. Even though there are no confirmed medications for treating
narcissistic personality disorder, people living with the condition might face other related
problems such as anxiety, depression, and drug abuse. Medications can be used to treat anxiety
and depression if they arise. Medication can also be used in this case to help Adam get over his
addiction to marijuana. Opioid use medications such as methadone can be used to help reduce
cravings for smoking the substance. Generally, Adam must keep an open mind towards
treatments, adhere to the treatment plans, learn about his condition, and focus on his goal.
Treatment Plan
Counselor Name:
Client Name: Adam
Case #:
Problem 1.: The client suffers from a lot of social and personal problems related to self-esteem.
H always feels he is superior to others and, at the same time, feels he does not get the attention
he needs.
NARCISSISTIC PERSONALITY DISORDER 5
Goal 1.: The client will learn about his problem and learn to be confident in himself and
others. He will be able to accept that other people, too, can be important just as he is.
Objective 1.: The client will undergo regular tests to determine his level of
tolerance towards others.
Intervention 1.: Th counselor will review the client’s completed behavior
in sessions by asking questions based on the DSM-5 diagnosis and other
necessary material.
Objective 2.: The client will try to make a friend every day.
Intervention 1.: The counselor will help the client learn ways to make
friends, how to talk and relate with others. The counselor will also advise
on things to avoid when interacting with others.
Goal 2.: The client will learn how to cope with other people to increase positive self-
esteem and love for others that help need for attention.
Objective 1.: The client will answer regular questions to see if he has any positive
views about others.
Intervention 1.: The counselor will review the client’s questions and try
to understand why the client has changed or not. The counselor will also
confirm regularly with the DSM-5 criteria to see if the client is improving.
NARCISSISTIC PERSONALITY DISORDER 6
Objective 2.: The client will provide a small list of people he has interacted with
to show he is indeed working on his condition.
Intervention 1.: The counselor will help the client increase the number of
people he interacts with. The counselor will also guide on how to interact
with different types of people with varying personalities.
Problem 2.: The client is engaging in drug abuse based on his revelation on the use of marijuana
as a means of gaining more insight and calmness.
Goal 1.: The client will try to avoid smoking marijuana. He will also avoid company that
might influence him to keep taking the drug. This is because he might consider such a
company as the only group that matches his level of intellect.
Objective 1.: The client will take drugs to help him avoid cravings for the drug.
Intervention 1.: The counselor will ensure that the client has taken his
medication and avoid bad company.
Objective 2.: The client will engage in sports and other activities to help him feel
more safe and important as opposed to taking drugs.
Intervention 1.: The counselor will insist on the importance and benefits
of regular exercise as opposed to the negative impacts of taking drugs.
